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After a Miscarriage: What Happens and How to Cope

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Recovering from a miscarriage—both physically and emotionally—takes time and patience. Here's what to expect from both your body and your mind.

Alexey Kuzma | Stocksy

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If you were rejoicing over a positive pregnancy test just weeks or months ago, coping with a sudden and unexpected miscarriage can be difficult. Even though you never saw your baby (except, perhaps, on ultrasound), you knew that he or she was growing inside of you (and you may have even formed a bond). You may have daydreamed about your baby and imagined yourself as a mother. And then, all the excitement of months (and years, and decades) came abruptly to a stop. Understandably, you may feel a range of emotions: sad and disheartened over the loss; angry and resentful it happened to you; possibly withdrawn from friends and family (especially those who are pregnant or just had babies). You may have trouble eating and sleeping at first and accepting the finality of it all. You may cry a lot, or you may not cry at all. These are all among the many natural, healthy responses to a pregnancy loss. (Remember: your reaction is what’s normal for you.)

Feeling in the dark about what happened, what to expect and what your next steps should be can make the situation even tougher. But keeping your partner and healthcare practitioner in the loop about your feelings (both physical and emotional) can help you through this time.

What is a miscarriage?

A miscarriage is when an embryo is expelled from the uterus before it can survive outside on its own. Often, the first sign this is happening is heavy bleeding accompanied by abdominal or back pain and cramping. Depending on how far along your pregnancy was, these symptoms can last for just a few days — like a normal period — or up to three or four weeks. If you experience any of these symptoms, see your doctor so he can diagnose the miscarriage and help you with the next steps.

What happens next

By the time you learn that you had a miscarriage or ever see a doctor, the process might be mostly over (the physical part at least) or not even begun. If you suspect a miscarriage, see your practitioner right away. She will confirm the miscarriage using an ultrasound to check if the pregnancy is growing normally or whether there’s a heartbeat, and she’ll possibly perform a pelvic exam to see if your cervix is dilated. She may also draw blood to check your hCG levels, your blood count (to determine how much blood was lost), and your blood type (to check for Rh incompatibility).

If your blood type is Rh negative, you may also receive a shot of Rh immunoglobulin (it’s possible for your blood to come into contact with fetal blood cells during a miscarriage — and this shot can prevent serious problems in later pregnancies).

Emptying the uterus

Once the miscarriage had been diagnosed, your uterus will need to be empty so your normal menstrual cycle can resume and you can try to get pregnant again, if you choose to. If your first sign of a miscarriage was heavy bleeding — especially if it was just a few weeks into pregnancy — then it’s possible that the miscarriage was “complete,” meaning all the fetal tissue has already been cleared out of your uterus. But sometimes — especially the later in the first trimester you are — a miscarriage isn’t complete, and parts of the pregnancy remain in the uterus (known as an incomplete miscarriage) that need to be removed. There are a number of ways this can be accomplished:

Expectant management. You may choose to let nature take its course and wait until the pregnancy is naturally expelled. Waiting out a missed or incomplete miscarriage can take anywhere from a few days to, in some cases, three or four weeks before your body takes care of things and you resume normal menstrual cycles.

Medication. If there’s no sign of your body expelling the embryo on its own, your healthcare practitioner might instead give you the option to take miscarriage medications — usually mifepristone or misoprostol — to help speed things along. Within a few days of taking a pill or receiving a vaginal suppository, you’ll start to expel fetal tissue and placenta. Just how long this takes varies from woman to woman, but typically it’s only a matter of days at the most before bleeding begins. These medications cause some of the same side effects that you might have experienced during watchful waiting: cramping, bleeding, nausea and diarrhea.

Surgery. Another option is to undergo a minor surgery called dilation and curettage (D&C). During this procedure, a doctor will gently scrape the fetus and placenta from your uterus. Bleeding following the procedure usually lasts no more than a week. Though side effects are rare, there is a slight risk of infection following a D&C.

How should you decide which route to take? Some factors you and your practitioner will take into account include:

How far along the miscarriage is. If bleeding and cramping are already heavy, the miscarriage is probably already well under way. In that case, allowing it to progress naturally may be preferable to a D&C. But if there is no bleeding (as in a missed miscarriage), misoprostol or a D&C might be better alternatives.

Your emotional and physical state. Waiting for a natural miscarriage to occur after a fetus has died in utero can be psychologically debilitating for a woman and her spouse. It’s likely that you won’t be able to begin coming to terms with — and grieving for — your loss while the pregnancy is still inside of you. Completing the process faster will also allow you to resume your menstrual cycles soon, and when and if the time is right, to try to conceive again.

Risks and benefits. Because a D&C is invasive, it carries a slightly higher (though still very low) risk of infection. The benefit of having a miscarriage complete sooner, however, may greatly outweigh that small risk for most women. With a naturally occurring miscarriage, there is also the risk that it won’t completely empty the uterus, in which case a D&C may be necessary to finish what nature has started.

Evaluation of the miscarriage. When a D&C is performed, evaluating the cause of miscarriage through an examination of the fetal tissue will be easier.

Resuming normal activities after a miscarriage

Whether or not you had a surgical procedure to treat your miscarriage, your doctor will let you know when it’s OK resume normal activities (like exercise and sex). While you may be able to get back to your usual routines right away, your practitioner may recommend that you don’t put anything in your vagina (which means abstaining from sex and avoiding using tampons) for two weeks to avoid infection. Make sure to see your health care provider for a follow-up appointment a few weeks after your miscarriage.

Complications

Even if your miscarriage progresses naturally and is relatively pain-free, your healthcare practitioner will likely want to check in with you for a few weeks or months to make sure you don’t develop any complications (don’t worry, these are all very rare). If you keep bleeding for more than seven days, this excessive bleeding can be a sign that there’s still placenta in the uterus, or that you’ve developed an infection. Other signs of an infection can include foul-smelling discharge, fevers, chills and abdominal pain. If your healthcare provider suspects an infection, she’ll likely treat it with a course of antibiotics. In extremely rare cases, retained products of conception (the technical term for any embryo or placenta left in your uterus) can start abnormally growing and form a type of tumor called a choriocarcinoma.

After a D&C, you’ll also have a slight risk of complications from the surgery. In around 16 percent of first D&Cs women develop scarring, called Asherman’s Syndrome, inside their uterus or around their cervix. It can take a second surgery to get rid of those scars, but luckily, you’ll likely recover and be able to get pregnant again.

Your emotions after miscarriage: The stages of grief

Whenever a pregnancy loss happens, you’re likely to experience many feelings and reactions. Though you can’t wish them away, understanding them will eventually help you come to terms with your loss. Many people who suffer a loss of any type go through a number of steps on their road to emotional healing. These steps are common, though the order in which the first three occur may vary; so too, may the feelings you experience.

Shock and denial. There may be numbness and disbelief, the feeling that “this couldn’t have happened to me.” This is a mental mechanism designed to protect your psyche from the trauma of loss.

Guilt and anger. Desperate to pin the blame for such a senseless tragedy on something, you may blame it on yourself (“I must have done something wrong to cause the miscarriage” or “If I’d been happier about the pregnancy, the baby would still be alive.”). Or you may blame others — God, for letting this happen, or your practitioner (eve if there is no reason to). You may feel resentful and envious of those around you who are pregnant or who are parents, and even have fleeting feelings of hatred for them.

Depression and despair. You may find yourself feeling sad most or all of the time, crying constantly, unable to eat, sleep, be interested in anything or otherwise function. You may also wonder if you’ll never be able to have a healthy baby.

Acceptance. Finally, you’ll come to terms with the loss. Keep in mind that this doesn’t mean you’ll forget the loss — just that you’ll be able to accept it and get back to the business of life.

Coping with grief after miscarriage

The grief you're feeling is real — and no matter how early in pregnancy you experienced the loss of a baby, you may feel that loss deeply. Some well-intentioned friends and family may try to minimize the significance of a loss with a “Don’t worry, you can try again,” not realizing that the loss of a baby, no matter when it occurs during a pregnancy, can be devastating. And the fact that there is no possibility of holding the baby, taking a photo, having a funeral and burial — rituals of grieving that can all help offer some closure for parents of stillborn infants — may complicate the recovery process.

Still, if you’ve suffered a miscarriage (or an ectopic or molar pregnancy), it’s important to remember that you have the right to grieve as much — or as little — as you need to. Do this in any way that helps you to heal and eventually move on.

Turn to your partner for support — remember that he's mourning the loss of a baby, too, though he may show his grief in a different way. Sharing your feelings openly with each other, rather than trying to protect each other, can help you both heal.

If you're religious, ask your pastor, priest, rabbi or spiritual leader for guidance. Perhaps you’ll find closure in a private ceremony with close family members or just you and your spouse. Or by sharing your feelings — individually, through a support group, with a friend or online — with others who experienced a miscarriage. Ask your practitioner to recommend a therapist or bereavement group to assist you through this difficult period.

Since so many women suffer a miscarriage at least once during their reproductive years (at least one in six pregnancies ends in miscarriage), you may be surprised to find how many others you know have had the same experience as you but never talked about it with you, or maybe never talked about it at all. (If you don’t feel like sharing your feelings — or don’t feel you need to — don’t. Do only what’s right for you.)

When will you feel normal again?

No matter what you’re feeling — and given your situation, your feelings may be all over the emotional map — give yourself time. Accept that you may always have a place in your heart for the pregnancy that you lost, and you may feel sad or down on the anniversary of the due date of your lost baby or on the anniversary of the miscarriage, even years later. If you find it helps, plan on doing something special at that time — at least for the first year or so — that will be cheering yet allows you to remember: planting some new flowers or a tree, having a quiet picnic in the park, sharing a commemorative dinner with your partner.

While it’s normal to mourn your loss — and important to come to terms with it your way — you should also start to feel gradually better as time passes. If you don’t, or if you have continued trouble coping with everyday life (you’re not eating or sleeping, you’re not able to focus at work, you’re becoming isolated from family and friends) or if you continue to feel very anxious (anxiety is an even more common symptom following miscarriage than depression is), professional counseling can help you to recover.

Getting pregnant again after a miscarriage

Healthcare providers used to recommend waiting a number of months before trying to get pregnant again after a miscarriage. They’ve learned, though, that the uterus is remarkably good at recovering from a miscarriage, and most doctors now say it’s okay to try again as soon as you’ve had one normal menstrual cycle. But check with your healthcare practitioner about your specific situation — if there’s scarring in your uterus or pieces of placenta left behind, she might recommend a longer wait. Even among women who have had four consecutive unexplained pregnancy losses, about 65 percent have a successful next pregnancy that ends in a live birth.

Try to remind yourself that you can — and most likely will — become pregnant again and give birth to a healthy baby. For the vast majority of women, a miscarriage is a one-time event — and actually, an indication of future fertility.

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